Asthma

Popular blue puffer won’t go quietly


Changing beliefs about SABA-only reliever therapy in order to implement the new GINA guidelines on asthma management isn’t going to be easy, an expert warns.

Because patients, and especially parents of paediatric patients, typically view SABAs very positively and have concerns about the ICS component of other inhaler medications.

Professor Robert Horne, director of the Centre for Behavioural Medicine in the School of Pharmacy at University College London, told the 2019 ERS Congress that such a paradigm shift in treatment advice would create an “information-action gap”.

While information was essential to enable adherence, just giving more information wouldn’t guarantee adherence – even when the information came from a trusted clinician.

He said instead, the information must either concur with existing patient beliefs or the beliefs had to change.

Professor Horne said that effective messaging had to motivate as well as inform and counter any misplaced default beliefs.

“To influence behaviour we need messages that can be used in clinical practice – that motivate a change and don’t just inform that the guidelines have changed.

“We need to tell a convincing story of why patients now need to disengage with a treatment that many of them have relied on for many years. So this is a big change.

“And we need to improve engagement with ICS and that means shifting beliefs about ICS and its necessity and lowering concerns.”

The good news was that in an online sample of 446 patients with asthma, many were open to the idea of anti-inflammatory treatment.

He said 71% of patients thought that a combined preventer and reliever in one inhaler was a good idea.

However many patients still harbour concern about the ICS with nearly 60% worrying about the long-term effects.

Dr Horne said in testing a number of short messages with the patients, misplaced beliefs such as the personal necessity for SABA were able to be changed, although not permanently.

“We can get an initial shift – beliefs are not set in stone – but what is very clear is that messages will need to be reinforced with further interventions. We need sustained input to get sustained change.”

“Similarly for beliefs about the necessity of ICS, they increase after exposure to the messages but then slide back.”

He said the high prevalence of attachment to SABA was unlikely to be overcome simply by changing guidelines.

“Many patients are initially unwilling to switch but these necessity beliefs and concerns can be changed in the right direction with intelligent messaging.”

Further discussion and support of patients was likely to be necessary.

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